African-American (AA) women with type 2 diabetes (T2D) living in the Southeastern US may have a higher risk of diabetes complications than other groups. One reason for this may be unique dietary self-care challenges that result from living in a region where dietary intake patterns conflict with diabetes guidelines. Diabetes medical nutrition therapy (MNT) is a type of dietary self-care support that is available and recommended for all persons with diabetes. However, it does not include specific strategies for motivating people to engage in recommended diabetes self-care behaviors. This is a critically important gap that should be filled for AA women with T2D, because many of them view lack of motivation or low motivation as a barrier to consistently engaging in dietary self-care. Without effective ways to combine MNT and motivational strategies, it may be hard for diabetes care teams to help AA women with T2D experience the positive diabetes outcomes that can result from MNT.
Motivational interviewing (MI) is a counseling method widely used to increase motivation for several behaviors. It has been successful in helping people with diabetes start and maintain recommended dietary self-care behaviors. In this study, we will test whether combining diabetes MNT with MI is more effective than diabetes MNT alone. The MI will be modified to address cultural factors that are known challenges for Southeastern AA women with T2D.
The study will enroll 240 AA women with T2D—120 women across two study sites—who are at risk for the development or progression of diabetes complications. At each site, the women will be divided between two groups. Both groups will participate in biweekly diabetes MNT sessions for three months (active period). This will be followed by a three-month period in which all women will participate in one session (maintenance period). Then, for six months, there will be no diabetes MNT sessions (no contact period). The only difference between the two groups will be that women in one group will also participate in MI activities that address cultural factors that influence dietary self-care.
After each study period, questionnaires and clinical tests will be used to assess women’s diabetes control using measures of blood glucose, blood pressure, and cholesterol. Other measures will include the assessment of dietary self-care (e.g., food choices) and weight control. Analyzing the results from these tests will help in determining whether the diabetes MNT plus MI sessions were more effective than the diabetes MNT sessions in improving these outcomes.
A paid patient advisory group, including AA women with T2D, will provide guidance throughout all study phases. A paid patient and community strategist will serve as a research team member that will also attend all patient advisory group meetings to ensure incorporation of patient advisory group input into research discussions and final decisions. Diabetes care team members will provide guidance throughout implementation and dissemination phases.
*All proposed projects, including requested budgets and project periods, are approved subject to a programmatic and budget review by PCORI staff and the negotiation of a formal award contract.